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Background: Oesophageal varices are the most critical porto-systemic shunts that develop secondary to portal hypertension, which is considered the main complication of liver cirrhosis. Many studies recommend the screening of all cirrhotic patients by endoscopy, but repeated endoscopic examinations are unpleasant for patients and have a high-cost impact and burden on endoscopic units. Objective: This study aimed to evaluate the accuracy of using the right liver lobe size/serum albumin ratio as a non-invasive predictor of esophageal varices in patients with HCV-related liver cirrhosis. Patients Methods: This prospective study included 30 patients with liver cirrhosis and 30 patients who underwent upper gastrointestinal endoscopy for any causes other than liver cirrhosis. All studied subjects underwent a detailed history and clinical examination, biochemical workup, upper gastrointestinal endoscopy, and abdominal ultrasound. The right liver lobe/serum albumin ratio was calculated for all patients. Results: There was a statistically significant difference between the control and the study subgroups as regards the Right lobe of the Liver/Albumin ratio (p-value 0.007). The diagnostic accuracy of the Right lobe of the Liver/Albumin ratio was assessed using the ROC curve which revealed a sensitivity of 86.67% and specificity of 73.33% at cut-off value >3.88, with an acceptable discriminative accuracy of 79.9%. Conclusion: The use of Right liver lobe/serum albumin ratio can help physicians by restricting the use of endoscopic screening only to patients presenting a high probability of esophageal varices. This is especially useful in clinical settings where resources are limited, and endoscopic facilities are not present in all areas. [ABSTRACT FROM AUTHOR]

Background: Hepatocellular carcinoma (HCC) is the fifth most common malignancy. Midkine (MK) is a cytokine or a growth factor belongs to the carbohydrate-binding proteins. MK is over expressed in hepatocellular carcinoma. Furthermore, patients with high MK expression in the tumor frequently have a worse prognosis than those with low MK expression. Objectives: The aim of the work was to evaluate serum midkine as a marker for Hepatocellular carcinoma in cirrhotic patients. Patients and Methods: This study was conducted on 90 subjects who were divided into three groups: group I included 40 patients with liver cirrhosis and hepatocellular carcinoma, group II included 40 patients with HCV related liver cirrhosis without HCC and group III with 10 healthy subjects as controls. Plasma level of midkine was measured for all subjects. Results: Serum levels of midkine were highest in patients of group I with HCC compared to those with liver cirrhosis and the control groups (p value< 0.001). Also midkine values increased with tumor number and overall size. According to the ROC curve, the best cutoff value for midkine differentiating HCC from liver cirrhosis cases was 8500pg/mL, above which the sensitivity to discriminate HCC = 100% and below which the specificity to discriminate liver cirrhosis = 87.5% with 94.5% accuracy. Conclusion: Serum midkine level was significantly elevated in HCC patients, so it can be used as a diagnostic marker for HCC. Also, it was directly correlated to the tumor number and overall size so it has a good prognostic value. [ABSTRACT FROM AUTHOR]